Clinical efficacy of tocilizumab treatment in severe and critical COVID-19 patients.

BACKGROUND: The main pathophysiological basis of coronavirus disease 2019 (COVID-19) causing respiratory failure is a cytokine storm and interleukin-6 (IL-6) is an important component of the COVID-19 cytokine storm. As a specific antagonist of IL-6, tocilizumab may block the cytokine storm of COVID-19. The Diagnosis and Treatment Guidelines of New Coronavirus Pneumonia (7th Edition) includes tocilizumab as a recommended drug for immunotherapy in severe and critical COVID-19 patients. However, the specific clinical efficacy of tocilizumab in the treatment of COVID-19 patients is worth studying. AIM: To determine the clinical efficacy of tocilizumab in inhibiting the cytokine storm in COVID-19. METHODS: In total, 19 severe and critical COVID-19 patients were enrolled in this study, and were treated with tocilizumab in Optical Valley Campus of Hubei Maternal and Child Health Care Hospital from February 20 to March 31, 2020. The imaging manifestations and clinical data before and after treatment were analyzed retrospectively, including routine peripheral venous blood tests, routine blood biochemical tests, coagulation test, C-reactive protein (CRP), IL-6, and arterial blood gas analysis. RESULTS: Of the 19 patients in this group, 13 (68.4%) had significantly improved symptoms of COVID-19 (5 patients were discharged directly and 8 patients were transferred after improvement) following treatment. One case was invalid, 1 case was exacerbated, and 4 deaths (21.1%) were observed (all critical cases). The lymphocyte count, CRP, lactic acid, oxygenation index, fibrinogen (FIB) and IL-6 levels were significantly different in the improved group. CONCLUSION: Tocilizumab treatment is effective against IL-6 in COVID-19 patients, but it does not completely inhibit the inflammation and cytokine storm in all patients with COVID-19.In the clinical treatment of COVID-19 patients, attention should be paid to the timing of drug administration and other adjuvant treatments.

Characteristics of white coat hypertension in Chinese Han patients with type 2 diabetes mellitus.

OBJECTIVES: This study documented the prevalence and clinical features of white coat hypertension (WCH) among Chinese Han patients with type 2 diabetes mellitus (T2DM). METHODS: Clinic and ambulatory blood pressure (BP) measurements were compared in 856 patients with T2DM to determine the frequency of WCH (WCH was defined as clinical blood pressure ≥140/90 mmHg and daytime blood pressure <135/85 mmHg and/or 24-h ambulatory BP (ABP) mean value of <130/80 mmHg on ambulatory BP monitoring (ABPM). Weight, waist circumference (WC), body mass index (BMI), waist to height ratio (WHtR), fasting blood glucose, glycosylated hemoglobin level and circadian BP patterns were also measured to find clinical features predictive of WCH in T2DM. RESULTS: The prevalence of WCH was 7.36% (63/856) in the overall population, 6.13% (29/473) in male and 8.88% (34/383) in female (p < 0.05). WCH accounted for 14.03% (63/449) of diagnosed hypertension. Age, course of T2DM, male WC were independent protective factors, whereas female sex, smoking and alcohol consumption were independent risk factors for WCH in T2DM. Non-dippers and reverse dippers made up larger proportion of the WCH group (p < 0.01). CONCLUSION: WCH is relatively common among T2DM patients, it is a unique condition distinct from essential hypertension (EH), and WCH patients also exhibit significant differences in clinical parameters.

Prevalence and distinguishing features of masked hypertension in type 2 diabetic patients.

OBJECTIVE: The prevalence and clinical features of masked hypertension (MH) in type 2 diabetes mellitus patients (T(2)DM) were investigated to define clinical indices which may aid diagnosis and treatment. METHODS: Clinical blood pressure (CBP) and ambulatory blood pressure (ABP) were measured in 856 T(2)DM patients to differentiate normotensive (NT), essential hypertensive (EH), and MH. Waist circumference (WC), abdominal circumference (AC), body mass index (BMI), waist to height ratio (WHtR), fasting blood glucose (FBG), and glycated hemoglobin levels were measured and compared between BP groups. RESULTS: In total, 359 patients had normal CBP, of which 13.37% were diagnosed with MH based on established criteria. Males had significantly higher rates of MH (15.30%) than females (11.36%) (P=0.036). The MH detection rate increased with age and T(2)DM duration. There were no significant differences in BMI, WC or WHtR between total MH and EH groups. MH females, however, had lower BMIs than female EH females (P=0.023). Smoking, alcohol, and familial EH history were lower in MH than EH patients (smoking, P=0.029; alcohol ,P=0.001; and EH history, P=0.000), while BMI (male, P=0.037, female, P=0.015), WC (male, P=0.012, female, P=0.021), WHtR (P=0.011), smoking (P=0.016), and alcohol consumption (P=0.000) were higher in MH than NT patients. BMI, WHtR, 6-15 year disease course of diabetes, smoking and alcoholism were independent risk factors of T(2)DM complicated with MH. The dipper BP circadian pattern was significantly lower in MH than NT patients (P=0.001). The non-dipper pattern was lower in MH than EH (P=0.018) but higher than in NT (P=0.000). CONCLUSIONS: A significant fraction of T(2)DM patients were diagnosed with MH. Clinical presentation also contrasted sharply from EH, MH is a specific blood pressure status that may severely damage target organs in T(2)DM.